الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 134 |  |  |
| | | from | 134 | | |
Abstract
Varicocele is the most common identified cause of male factor infertility. The detrimental effect on spermatogenesis by varicocele is well documented, but not completely understood. Nonetheless, varicocelectomy has been shown to improve semen parameters in infertile men and approximately improves pregnancy as a result. Defective testosterone synthesis has been reported to be associated with varicocele, probably through intratesticular hyperthermia, which inhibits 17a-hydroxyprogesterone aldolase, an enzyme responsible for the conversion of 17a-hydroxyprogesterone to testosterone. This may be explained by the recovery of testosterone synthesis, essential for epididymal function, the removal of the hyperthermic effects of the varicocele and the amelioration of epididymal function, resulting in testicular hypothermia. The defects in semen parameters due to varicocele are variable. The defects in sperm concentrations, motility, and morphology usually occur concomitantly, but isolated defects may also be present in some patients. The studies conducted prior to 2011 have yielded results that are difficult to interpret, which has led to equivocal statements about the utility of varicocele repair for correcting hypogonadal levels of testosterone. Several recent studies, however, have produced consistent evidence for both the harmful effects of varicocele on testosterone production and for the restoration of normal testosterone levels following varicocele repair in men with below-normal testosterone levels. The effect of varicocelectomy on serum testosterone level is not yet fully established. While some studies found no significant effect, others reported a normalization of the testosterone level following surgical repair of the varicocele. Regarding to this debatable issue that still investigated. The aim of the current study was to evaluate the role of varicocelectomy on infertile patients with low versus normal serum Testosterone level. This study was done prospectively on 134 infertile men diagnosed to have clinical varicocele and were divided into two groups: group A (56 patients) with low testosterone level. group B (78 patients) with normal testosterone level. In the present study, there was a statistically significant improvement in sperms count, motility and abnormal forms in each group after 3 and 6 months. But there was no statistically significant difference between the two groups after 3 and 6 months postoperatively regarding these parameteres. In our study, serum testosterone levels elevated significantly in both groups, and FSH decreased significantly in group A after 3 and 6 months postoperatively, but we detected no significant change prolactin and eostrogen in each group after 3 and 6 months postoperatively. Regarding serum testosterone and FSH levels, the degree of improvement was statistically significant different between the two groups after 3 and 6 months. But there was no statistically significant difference between the two groups after 3 and 6 months regarding prolactin and eostrogen. Pregnancy rate improved in each group, but with no statistically significant difference between the two groups. Additional studies with more patients are invited to consolidate the results of the present study. In conclusion, the results of this study show that varicocelectomy could improve semen parameters (count, motility and abnormal forms) and increase the serum testosterone level, and this increase is statistically significant. However, pregnancy rate improved in group B more than group A but, still comparable with insignificant statistical difference between the two groups.